Associations Between Copper and Zinc and Risk of Hypertension in US Adults

  • Jie Yao
  • Ping Hu
  • Dongfeng Zhang


Evidence linking copper and zinc to hypertension are limited and conflicting. Data from the National Health and Nutrition Examination Survey (NHANES) 2007–2014 were used. Zinc and copper intake from diet and supplements was assessed with 24-h dietary recall. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg/diastolic blood pressure (DBP) ≥ 90 mmHg/treatment with hypertensive medications. In a sensitivity analysis, according to the 2017 American College of Cardiology and American Heart Association guideline, hypertension was also defined as SBP ≥ 130 mmHg/DBP ≥ 80 mmHg/treatment with hypertensive medications. A total of 17,811 adults (8430 men and 9381 women) were included. After adjustment for age, gender, body mass index (BMI), race, educational level, smoking status, family income, and total daily energy intake, the OR of hypertension for highest vs. lowest quartile intake of copper, zinc, and copper/zinc ratio was 1.11 (0.90–1.37), 1.11 (0.90–1.35), and 0.95 (0.81–1.11), respectively. In stratified analysis by BMI (< 25 kg/m2, 25–30 kg/m2, > 30 kg/m2), no significant association was found between hypertension and intakes of copper, zinc, and copper/zinc ratio (highest vs. lowest quartile) in multivariate analysis. In multivariate analysis, the OR of hypertension for highest vs. lowest quartile levels of serum copper, zinc, and copper/zinc ratio was 1.11 (0.61–2.04), 1.43 (0.84–2.44), and 0.68 (0.34–1.33), respectively. Similar results were found in the sensitivity analysis. Zinc and copper might be not independently associated with hypertension in US adults.


Zinc Copper Copper/zinc ratio Hypertension 



We thank all staffs at the National Center for Health Statistics of the Centers for Disease Control and Prevention who were responsible for the planning and administering of NHANES and making the datasets of NHANES available on the website.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study, formal consent is not required

Supplementary material

12011_2018_1320_MOESM1_ESM.doc (256 kb)
ESM 1 (DOC 255 kb)


  1. 1.
    WHO (2013) A global brief on hypertension. Accessed Jan. 31, 2018
  2. 2.
    Lu J, Lu Y, Wang X, Li X, Linderman GC, Wu C, Cheng X, Mu L, Zhang H, Liu J, Su M, Zhao H, Spatz ES, Spertus JA, Masoudi FA, Krumholz HM, Jiang L (2017) Prevalence, awareness, treatment, and control of hypertension in China: data from 1.7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet 390:2549–2558CrossRefPubMedGoogle Scholar
  3. 3.
    Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, AlMazroa MA, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan-Hancock C, Bucello C, Buchbinder R, Bull F, Burnett RT, Byers TE, Calabria B, Carapetis J, Carnahan E, Chafe Z, Charlson F, Chen H, Chen JS, Cheng ATA, Child JC, Cohen A, Colson KE, Cowie BC, Darby S, Darling S, Davis A, Degenhardt L, Dentener F, Des Jarlais DC, Devries K, Dherani M, Ding EL, Dorsey ER, Driscoll T, Edmond K, Ali SE, Engell RE, Erwin PJ, Fahimi S, Falder G, Farzadfar F, Ferrari A, Finucane MM, Flaxman S, Fowkes FGR, Freedman G, Freeman MK, Gakidou E, Ghosh S, Giovannucci E, Gmel G, Graham K, Grainger R, Grant B, Gunnell D, Gutierrez HR, Hall W, Hoek HW, Hogan A, Hosgood HD III, Hoy D, Hu H, Hubbell BJ, Hutchings SJ, Ibeanusi SE, Jacklyn GL, Jasrasaria R, Jonas JB, Kan H, Kanis JA, Kassebaum N, Kawakami N, Khang YH, Khatibzadeh S, Khoo JP, Kok C, Laden F, Lalloo R, Lan Q, Lathlean T, Leasher JL, Leigh J, Li Y, Lin JK, Lipshultz SE, London S, Lozano R, Lu Y, Mak J, Malekzadeh R, Mallinger L, Marcenes W, March L, Marks R, Martin R, McGale P, McGrath J, Mehta S, Memish ZA, Mensah GA, Merriman TR, Micha R, Michaud C, Mishra V, Hanafiah KM, Mokdad AA, Morawska L, Mozaffarian D, Murphy T, Naghavi M, Neal B, Nelson PK, Nolla JM, Norman R, Olives C, Omer SB, Orchard J, Osborne R, Ostro B, Page A, Pandey KD, Parry CDH, Passmore E, Patra J, Pearce N, Pelizzari PM, Petzold M, Phillips MR, Pope D, Pope CA III, Powles J, Rao M, Razavi H, Rehfuess EA, Rehm JT, Ritz B, Rivara FP, Roberts T, Robinson C, Rodriguez-Portales JA, Romieu I, Room R, Rosenfeld LC, Roy A, Rushton L, Salomon JA, Sampson U, Sanchez-Riera L, Sanman E, Sapkota A, Seedat S, Shi P, Shield K, Shivakoti R, Singh GM, Sleet DA, Smith E, Smith KR, Stapelberg NJC, Steenland K, Stöckl H, Stovner LJ, Straif K, Straney L, Thurston GD, Tran JH, van Dingenen R, van Donkelaar A, Veerman JL, Vijayakumar L, Weintraub R, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams W, Wilson N, Woolf AD, Yip P, Zielinski JM, Lopez AD, Murray CJL, Ezzati M (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2224–2260CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Artinian NT, Fletcher GF, Mozaffarian D, Kris-Etherton P, van Horn L, Lichtenstein AH, Kumanyika S, Kraus WE, Fleg JL, Redeker NS, Meininger JC, Banks J, Stuart-Shor EM, Fletcher BJ, Miller TD, Hughes S, Braun LT, Kopin LA, Berra K, Hayman LL, Ewing LJ, Ades PA, Durstine JL, Houston-Miller N, Burke LE, on behalf of the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing (2010) Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation 122:406–441CrossRefPubMedGoogle Scholar
  5. 5.
    Lichtenstein AH, Appel LJ, Brands M et al (2006) Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 114:82–96CrossRefPubMedGoogle Scholar
  6. 6.
    Li B, Li F, Wang L, Zhang D (2016) Fruit and vegetables consumption and risk of hypertension: a meta-analysis. J Clin Hypertens (Greenwich) 18:468–476CrossRefGoogle Scholar
  7. 7.
    Hu D, Huang J, Wang Y, Zhang D, Qu Y (2014) Fruits and vegetables consumption and risk of stroke: a meta-analysis of prospective cohort studies. Stroke 45:1613–1619CrossRefPubMedGoogle Scholar
  8. 8.
    Mohammadifard N, Salehi-Abargouei A, Salas-Salvado J et al (2015) The effect of tree nut, peanut, and soy nut consumption on blood pressure: a systematic review and meta-analysis of randomized controlled clinical trials. Am J Clin Nutr 101:966–982CrossRefPubMedGoogle Scholar
  9. 9.
    Bergomi M, Rovesti S, Vinceti M, Vivoli R, Caselgrandi E, Vivoli G (1997) Zinc and copper status and blood pressure. J Trace Elem Med Biol 11:166–169CrossRefPubMedGoogle Scholar
  10. 10.
    Taneja SK, Mandal R (2007) Mineral factors controlling essential hypertension—a study in the Chandigarh, India population. Biol Trace Elem Res 120:61–73CrossRefPubMedGoogle Scholar
  11. 11.
    Suliburska J, Bogdanski P, Pupek-Musialik D et al (2011) Dietary intake and serum and hair concentrations of minerals and their relationship with serum lipids and glucose levels in hypertensive and obese patients with insulin resistance. Biol Trace Elem Res 139:137–150CrossRefPubMedGoogle Scholar
  12. 12.
    Chiplonkar SA, Agte VV, Tarwadi KV, Paknikar KM, Diwate UP (2004) Micronutrient deficiencies as predisposing factors for hypertension in lacto-vegetarian Indian adults. J Am Coll Nutr 23:239–247CrossRefPubMedGoogle Scholar
  13. 13.
    Li Y, Ma A, Sun Y, Liang H, Wang Q, Yi X, Han X (2009) Magnesium status and dietary intake of mid-old people in a rural area of China. Magnes Res 22:66–71PubMedGoogle Scholar
  14. 14.
    Kim J (2013) Dietary zinc intake is inversely associated with systolic blood pressure in young obese women. Nutr Res Pract 7:380–384CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Cifu AS, Davis AM (2017) Prevention, detection, evaluation, and management of high blood pressure in adults. JAMA 318:2132–2134CrossRefPubMedGoogle Scholar
  16. 16.
    Moshfegh AJ, Rhodes DG, Baer DJ, Murayi T, Clemens JC, Rumpler WV, Paul DR, Sebastian RS, Kuczynski KJ, Ingwersen LA, Staples RC, Cleveland LE (2008) The US Department of Agriculture Automated Multiple-Pass Method reduces bias in the collection of energy intakes. Am J Clin Nutr 88:324–332CrossRefPubMedGoogle Scholar
  17. 17.
    Wu W, Jiang S, Zhao Q, Zhang K, Wei X, Zhou T, Liu D, Zhou H, Zeng Q, Cheng L, Miao X, Lu Q (2018) Environmental exposure to metals and the risk of hypertension: a cross-sectional study in China. Environ Pollut 233:670–678CrossRefPubMedGoogle Scholar
  18. 18.
    Lee YK, Lyu ES, Oh SY, Park HR, Ro HK, Heo YR, Hyun T, Choi MK (2015) Daily copper and manganese intakes and their relation to blood pressure in normotensive adults. Clin Nutr Res 4:259–266CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kim MH, Choi MK (2013) Seven dietary minerals (Ca, P, Mg, Fe, Zn, Cu, and Mn) and their relationship with blood pressure and blood lipids in healthy adults with self-selected diet. Biol Trace Elem Res 153:69–75CrossRefPubMedGoogle Scholar
  20. 20.
    Canatan H, Bakan I, Akbulut M, Halifeoglu I, Cikim G, Baydas G, Kilic N (2004) Relationship among levels of leptin and zinc, copper, and zinc/copper ratio in plasma of patients with essential hypertension and healthy normotensive subjects. Biol Trace Elem Res 100:117–123CrossRefPubMedGoogle Scholar
  21. 21.
    Kunutsor SK, Laukkanen JA (2016) Serum zinc concentrations and incident hypertension: new findings from a population-based cohort study. J Hypertens 34:1055–1061CrossRefPubMedGoogle Scholar
  22. 22.
    Suarez-Varela MM, Llopis-Gonzalez A, Gonzalez Albert V et al (2015) Zinc and smoking habits in the setting of hypertension in a Spanish populations. Hypertens Res 38:149–154CrossRefPubMedGoogle Scholar
  23. 23.
    Pavlyushchik O, Afonin V, Fatykhava S, Shabunya P, Sarokina V, Khapaliuk A (2017) Macro- and microelement status in animal and human hypertension: the role of the ACE gene I/D polymorphism. Biol Trace Elem Res 180(1):110–119CrossRefPubMedGoogle Scholar
  24. 24.
    Osorio-Yañez C, Gelaye B, Miller RS, Enquobahrie DA, Baccarelli AA, Qiu C, Williams MA (2016) Associations of maternal urinary cadmium with trimester-specific blood pressure in pregnancy: role of dietary intake of micronutrients. Biol Trace Elem Res 174(1):71–81CrossRefPubMedGoogle Scholar
  25. 25.
    Lee BK, Ahn J, Kim NS, Lee CB, Park J, Kim Y (2016) Association of Blood Pressure with Exposure to Lead and Cadmium: analysis of data from the 2008-2013 Korean National Health and Nutrition Examination Survey. Biol Trace Elem Res 174(1):40–51CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Epidemiology and Health StatisticsSchool of Public Health of Qingdao UniversityQingdaoPeople’s Republic of China
  2. 2.Jiangsu Institute of Planning Parenthood ResearchNanjingPeople’s Republic of China
  3. 3.Department of Chronic Non-communicable DiseasesQingdao Municipal Centers for Diseases Control and PreventionQingdaoChina

Personalised recommendations